Maverick group bent on improving care of dying

As his brother lay dying of an aggressive brain tumor, Dr. Sherm Franz and other family members — including the brother — received care, comfort and counseling through Hospice of South Central Indiana.

In the last week of his brother’s life, Dr. Franz stayed in Loren’s home near Henryville, typically sleeping during the day and

standing watch at night over Loren’s bed in the living room.

His eyes lit up as he thought back to an anecdote he remembered from that last week: Franz never smoked, but Loren had, and one night Loren looked up at him and moved his fore and middle fingers to his mouth, indicating that he wanted to smoke.

Loren could not light the cigarette on his own. Franz lit the cigarette and handed it to his older brother, who cracked a smile because he got his younger, nonsmoking brother to light a cigarette for him.

“That was kind of humorous to us both,” Franz said.

Franz also witnessed the hospice nurse who administered pain medication to keep Loren as comfortable as possible and the hospice aide who stopped by three days a week to bathe him.

After Loren’s death, the hospice offered bereavement counseling, and hospice personnel checked in with Franz, his wife and his sister-in-law six and 12 months after the death.

“We all felt that support,” Franz said. “It was like they had their arms around us.”

“I was very thankful that hospice (was) here,” he said. “And it served us very well as a family.”

Three more of Franz’ family members — his mother, mother-in-law and father-in-law — received hospice care, all while staying at Four Seasons Retirement Center.

Their contact with hospice was shorter, “but no less helpful,” Franz said.

As Franz was among the handful of early proponents of hospice care in Bartholomew County in the late 1970s, at a time that hospice was little known in the state and nation, the care Franz and his family received evoked for him a sense of providence.

Advocates of change

Franz, 75, on a recent Wednesday descended the stairs of his Parkside home and stepped into the basement, where, in 1978, he hosted a group of Columbus mavericks bent on changing care of the dying.

The group included Dale Evans, the late Father Joseph McNally and Sandy Carmichael, then a nurse with Bartholomew County Hospital. Carmichael would lead the organization from infancy to maturity through more than three decades, as hospice care first gained attention, then acceptance and finally popularity.

Carmichael and Dr. Ben Rank were the first two people hired for the local hospice organization in 1980. Rank still works there two days a week.

In the late 1970s, however, the idea of providing care for the terminally ill in their homes was nothing short of revolutionary. The prevailing attitude at the time: The sick belong in the hospital.

But Evans, whom Franz knew through church, had read a lot about hospice care in the United Kingdom, where the modern hospice movement originated in the middle of the last century. She shared her information with Franz, McNally and others and called for a meeting of co-conspirators in Franz’ basement.

Carmichael said that, at the time, none of the group members knew a whole lot about hospice care. The group decided to do more research, and Carmichael traveled to Yale to witness the groundbreaking of a hospice facility.

“‘This is what I wanted to do,’” Carmichael remembers thinking.

The more Carmichael looked into hospice, the greater her conviction that it was the right approach.

The hospital provided access to its records, and Carmichael’s research revealed that the average length of stay for people who died in the hospital was 72 days over six months.

That meant the terminally ill were taken to the hospital when they suffered severe pain, stayed there for a few days until their pain had been managed, then they would be sent back home — only to return a few days later.

Carmichael said some people at the time thought that there must be a better way, a less complicated, less intrusive way to help the dying.

Hospice provides care for terminally ill patients primarily in their homes, through doctors, nurses and aides.

Modest start

The early days of the local hospice movement proved difficult, primarily because of financial and public relations challenges. The local organization started with $28.

“We passed the hat one day,” Carmichael said.

She said the early proponents struggled even more to spread the word about hospice care and persuade people to support their efforts.

Some people did not think that we would succeed in raising enough funds and changing attitudes, Carmichael said.

“I wasn’t even sure whether I knew it would work,” she said.

Howard Pearcy, one of the founding board members, said hospice proponents initially had to spend a lot of time convincing people that hospice was not about euthanasia but dignity in dying.

Pearcy, who worked at Irwin Management at the time, said hospice care primarily serves to provide palliative care, help the family of the dying and provide help with grieving after the loved one’s death.

“It just made sense to me that if you were terminally ill that there ought to be ... a sensible approach to the end,” Pearcy said.

Carmichael said that the local hospice organization thrived because it received strong support from some local physicians and because of good word of mouth. Family members who received support through hospice told their neighbors and friends; and over the years, more people started inquiring about hospice care.

Today, Our Hospice of South Central Indiana, a nonprofit, provides care for more than 200 patients a day, including up to 14 at its inpatient facility east of Columbus Regional Hospital. About two-thirds of the patients are in assisted-living facilities. The organization serves 15 counties, reaching from Johnson and Shelby counties in the north to Clark County, at the Kentucky border, in the south.

Our Hospice employs 140, primarily nurses, but also home-health aides, social workers, chaplains and three part-time doctors. The organization also receives support from nearly 300 volunteers. Ninety percent of its annual $12 million budget is paid through reimbursements, primarily through Medicare.